Approximately 25% of adults experience knee pain, with osteoarthritis being the leading cause. Over time, the cartilage that cushions the bones in the knee can become thinner. However, modifying one’s lifestyle can help to postpone further harm and enhance knee function. Multiple research studies have consistently shown that exercise is just as effective as over-the-counter drugs for knee osteoarthritis, and is also deemed to be safer. In a recent meta-analysis published in the British Journal of Sports Medicine, it was concluded that exercise provides a safe alternative for managing knee osteoarthritis.
Why Exercise Works
According to Christopher Visco, MD, an associate professor of rehabilitation medicine at Columbia University Vagelos College of Physicians and Surgeons in New York City, physical activity has the potential to compress cartilage, thereby stimulating a healing response in the cells. Additionally, it can strengthen the muscles surrounding the knees, thus minimizing further strain on the cartilage. Maintaining a healthy weight is also crucial in relieving joint pain, which can be facilitated by regular exercise. Anthony DiGioia, MD, the medical director of the Bone and Joint Center at University of Pittsburgh Medical Center Magee Womens Hospital, states that even a pound of weight can exert a significant amount of pressure on the knees and hips, equating to roughly five or six pounds.
To prevent pain and arthritis, low-intensity aerobic exercises such as swimming, biking, walking, or using an elliptical are highly recommended. Seeking assistance from a physical therapist can be beneficial in devising an exercise regimen tailored to one’s specific needs. To reduce the risk of injury, Visco recommends incorporating stretching exercises before engaging in any physical activity.
Alternative Measures to Alleviate Knee Pain
According to Visco, the application of heat may ease morning stiffness, while ice can be used when experiencing warmth and pain in the knee. Although braces provide a sense of stability, they do not prevent symptoms from worsening.
Over-the-counter creams containing menthol (e.g. Bengay) or capsaicin (e.g. Capzasin) may reduce discomfort. Topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac gel, can also reduce inflammation associated with osteoarthritis (OA). It is advisable to start with creams instead of oral NSAIDs, as the latter may cause stomach issues and increase the risk of heart problems. However, Visco recommends the judicious use of NSAIDs, as prolonged use can cause organ damage or impair the joints’ capacity for self-repair. Opioids are not typically recommended, according to Savyasachi C. Thakkar, MD, chair of orthopedic surgery at Johns Hopkins Howard County General Hospital.
Exercise caution with Injections
Injections may provide temporary relief, but they also carry risks. Steroids can alleviate inflammation for several months, but they suppress the immune system. Although hyaluronic acid injections have been touted as effective in relieving OA knee pain, research has shown that they do not offer significant relief. Platelet-rich plasma injections are also controversial, and a recent study found that they do not provide more relief than a placebo. In addition, insurance does not generally cover these types of injections, according to DiGioia.
When Knee Surgery is Necessary
If knee pain is interfering with daily activities, other treatments are ineffective, and X-rays show a loss of knee cartilage, surgery may be recommended. Some physicians may suggest arthroscopic surgery to remove a torn meniscus, a cartilage pad that absorbs shock in the knee. However, this surgery is not suitable for patients with osteoarthritis-related tears. Studies indicate that repairing menisci in individuals with OA is no more effective than physical therapy. While arthroscopic surgery may be beneficial for younger people with injury-related meniscus tears, trimming the torn meniscus does not replace damaged cartilage, notes Anthony DiGioia, MD. Knee replacement surgery is a more effective option, and it can considerably alleviate pain. However, it is reserved for severe cases where there is little or no knee cartilage remaining. Early diagnosis and treatment are preferable when feasible.
